[The importance of a veterinary anaesthetist and pain treatment according to dog and cat owners]. / Bedeutung einer Veterinäranästhesistin oder eines Veterinäranästhesisten und einer optimalen Schmerztherapie aus Sicht von Hunde- und Katzenbesitzerinnen und -besitzer.

INTRODUCTION: In Switzerland, compared to the United Kingdom or the United States of America, fewer veterinary anaesthetists are employed in private practice, which raises the question about the reason. The present survey aimed at investigating the awareness of pet owners concerning the specialization of veterinary anaesthesia and the value they attribute to such a specialist. Also, estimation of pain in dogs and cats and the importance of its treatment from the point of view of the pet owners was analysed. Furthermore, the necessity of veterinary anaesthetists in private practice and the influencing factors were investigated. The survey was created on LimeSurvey, an online tool for questionnaires and sent to dog and cat owners of the small animal clinic of the University Hospital of Zurich. 317 fully completed questionnaires were evaluated. In general, pet owners appreciated the specialization of veterinary anaesthesiology. Great importance was attributed to the supervision of anaesthesia and analgesic therapy by a specialist. A preliminary talk with an anaesthetist would be appreciated. Owners would be willing to cover additional costs for a specialized anaesthetist, if recommended by the private veterinarian, and to bring their animal to the University Hospital, in case of an increased anaesthetic risk.

INTRODUCTION: En Suisse, les vétérinaires anesthésistes sont moins nombreux à exercer en cabinet privé qu'au Royaume-Uni ou aux États-Unis. La question se pose dès lors de savoir pourquoi il en est ainsi. Une enquête a analysé les connaissances des propriétaires d'animaux de compagnie sur la spécialisation de l'anesthésiologie vétérinaire et l'importance qu'ils accordent à un spécialiste en la matière. L'importance de la thérapie analgésique chez les chiens ou les chats a également été évaluée. En outre, le besoin en vétérinaires anesthésistes en pratique privée et les facteurs qui l'influencent ont été examinés. L'enquête a utilisé l'outil de questionnaire Lime-Survey et a été envoyée aux propriétaires de chiens et de chats de la Clinique des petits animaux de l'Université de Zürich. 317 questionnaires complétés ont été évalués. Les propriétaires d'animaux apprécient la spécialisation en l'anesthésiologie vétérinaire. Le vétérinaire anesthésiste est considéré comme très important dans les mesures anes-thésiques et la thérapie analgésique. Une consultation anesthésique préalable est souhaitée. Les propriétaires seraient disposés à prendre en charge les coûts supplémentaires de ce service ou, sur recommandation du vétérinaire privé, à amener leur animal à la Clinique pour petits animaux de l'Université de Zürich en cas de risque anesthésique accru.

[Establishment of analysis groups of professional nursing practice in mental health]. / Implantation de groupes d'analyse de la pratique professionnelle infirmière en santé mentale.

In mental health, as elsewhere, nurses are increasingly faced with clinical and organizational problems. At a time when the nursing profession is experiencing new perspectives through advanced practice, particularly in psychiatry and mental health, a cross-sectional view is proposed on the implementation of an experimentation of analysis groups of professional nursing practice at the Nancy psychotherapeutic center (54). The strengths, limits and perspectives of this system are presented for the teams, their management and for the clinical nurse specialist who leads the sessions.

[Nurses' feedback on advanced nursing practice in mental health]. / Réflexion de terrain sur le métier d'infirmier en pratique avancée en santé mentale.

Nurses will soon be able to develop advanced practice in mental health through a state certified diploma. This new role will see caregivers acquire other competencies, such as prescribing, and marks a development of the profession through the growth of nursing sciences. The evolution of practices and the clinical approach in care would gain from collaboration between advanced practice nurses undergoing training and qualified clinical nurse specialists. Based on feedback from nurses in the field, perspectives for collaboration and organisation are assessed in terms of the health challenges facing our society.

Clínica extensa: interfaces da psicanálise e da educação / Extensive clinic: interfaces of psychoanalysis and education / Clínica extensa: interfaz de psicoanálisis y educación / Clinique extensive: interfaces entre psychanalyse et éducation

Este artigo apresenta a experiência de três psicanalistas que, juntos, acompanharam um grupo de educadores impactados com o crescente número de ameaças de suicídio e de suicídios consumados entre os alunos de suas diversas unidades escolares. O desamparo, a impotência e a angústia caracterizavam os relatos que chegavam como um pedido de socorro. Como evitar que novos episódios trágicos ocorressem? O que deveriam saber que garantisse o manejo adequado e preventivo? Sentiam-se perdidos diante dessa realidade inusitada. A psicanálise enquanto método promoveu um processo de ressignificação dos elementos apresentados, recolocando os educadores como possuidores de competências e conhecimentos suficientes para lidar com esse fenômeno, que tem implicações predominantemente de ordem social e também psíquica

This article presents the experience of three psychoanalysts who worked together with a group of educators who were under the impact of the growing number of suicidal threats and actual suicides within their school systems. The educators' discourses were characterized by the feelings of helplessness, impotence and anxiety, and came as a cry for help. How do they avoid tragic episodes from happening again? What should they know to help prevent such situations and how to deal with them when they happen? Educators were felling lost facing such uncommon reality. Psychoanalysis as a method promoted a process to re-signify the presented new elements, bringing the educators knowledge and competence to deal with this phenomenon that has such psychological and social implications.

Esta artículo presenta la experiencia de tres psicoanalistas que, juntos, acompañaron a un grupo de educadores impactados por el creciente número de amenazas y suicidios consumados entre estudiantes de sus diversas unidades escolares. El desamparo, la impotencia y la angustia caracterizaron los relatos como un pedido de socorro. ¿Cómo evitar que ocurran nuevos episodios trágicos? ¿Qué deberían saber para garantizar una conducción adecuada y preventiva? Se sintieron perdidos frente a esta realidad inusual. El psicoanálisis como método promovió un proceso de resignificación de los elementos presentados, reubicando a los educadores como poseedores de suficientes habilidades y conocimientos para enfrentar este fenómeno que tiene implicaciones predominantemente sociales y psíquicas.

Cet article présente l'expérience de trois psychanalystes qui ont accompagné ensemble un groupe d'éducateurs sous l'impact du nombre croissant de menaces et de suicides accomplis, ayant lieu parmi les élèves de leurs diverses unités scolaires. Le désarroi, l'impuissance et l'angoisse caractérisaient les rapports qui arrivaient comme un appel à l'aide. Comment éviter que de nouveaux épisodes tragiques arrivent-ils? Ce que devraient-ils savoir qui serait capable de garantir une façon de faire adéquate et préventive ? Ils se sentaient perdus devant cette réalité inusitée. La psychanalyse en tant que méthode a promu un processus qui a établi une nouvelle signification des éléments rapportés, en remettant les éducateurs en possession de compétences et connaissances suffisantes pour affronter ce phénomène qui a des implications en particulier d'ordre social et aussi psychique.

[Tooth Loss in Modern Dentistry]. / Zahnverlust in der modernen Zahnmedizin ­ was jetzt?

Tooth Loss in Modern Dentistry Abstract. The Swiss population follows the trend of other industrialized countries and shows an increased life expectancy compared to previous generations. Old age is reached increasingly with one's own teeth. Older restorations of teeth must be replaced and produced anew. Previous reconstructions often have the disadvantage that they are invasive and reinterventions or new fabrications are only possible to a limited extent. Advances in material technology allow new minimally invasive therapies. Adhesive bridges have become possible due to material developments in material science and allow aesthetic, non-invasive, long-term stable solutions. The specialist dentist SSO for Reconstructive Dentistry is the expert for the rehabilitation of teeth after tooth loss. He takes care of the careful restoration of the teeth according to functional and aesthetic criteria and draws on a sound knowledge of therapy options, techniques and materials acquired in many years of additional training.

Glycated Hemoglobin Level Goal Achievement in Adults With Type 2 Diabetes in Canada: Still Room for Improvement.

OBJECTIVES: To describe the clinical histories and management of adults with type 2 diabetes who were not reaching their target glycated hemoglobin (A1C) levels and to identify barriers to achieving therapeutic goals. METHODS: Practice assessment surveys and practice audits were completed by 88 primary care physicians (PCPs) in the Diabetes Mellitus Assessment of Clinical managemenT In ONtario (DM-ACTION) program and by 56 diabetes specialists in the Diabetes Mellitus IMproving PAtient Care in our communiTies (DM-IMPACT) program. The DM-ACTION audit analyzed data from 1,173 adults with A1C levels ≥7.3% who were not prescribed insulin; the DM-IMPACT audit included 135 individuals with similar characteristics. RESULTS: Most PCPs (92%) and specialists (88%) stated that they typically recommend A1C levels of ≤7.0%; more than 90% indicated that they adjusted antihyperglycemic therapy within 3 months if suboptimal A1C targets endured. Among the DM-ACTION patients, the median A1C level was 7.8%; the median time between the last 2 A1C tests was 5 months; 58% were taking ≤2 noninsulin antihyperglycemic agents; and adjustment of glucose-lowering therapy was noted for only 56%. The corresponding values for the DM-IMPACT patients were 8.0%, 4 months, 43% and 68%, respectively. PCPs and specialists attributed patients' factors and patients' adherence as primary causes of poor achievement of guideline-recommended targets. PCPs perceived patients' factors as the predominant barrier to optimizing care, but the specialists believed that therapeutic inertia stems from a wide range and a varied combination of patient-centric factors. CONCLUSIONS: Type 2 diabetes remains a health-care challenge in Canada and globally. Primary care physicians and specialists attributed patients' factors as principal obstacles to optimal diabetes management. However, physician-associated therapeutic inertia may also be an important barrier to unmet therapeutic goals.

Le modèle de pratique des infirmières spécialistes cliniques aux Hôpitaux universitaires de Genève.

THE CLINICAL NURSE SPECIALIST PRACTICE MODEL AT GENEVA UNIVERSITY HOSPITALS.: A clinical nurse specialist practice model has been implemented at Geneva University Hospitals. It details the five dimensions of the function-clinical practice, coaching-consultation-guidance, research, leadership and collaboration, ethics-and its three spheres of influence-patients and their family, nursing teams, institutions. Arising from practice rather than the world of academia, it constitutes a tool to aid reflection among the nursing profession.

[Patient- vs Physician-Reported Implementation of and Compliance to Anti-Osteoporotic Medication One Year after Sustained Fragility Fracture]. / Keine Therapie trotz spezifischer Facharzt-Empfehlung?

Patient- vs Physician-Reported Implementation of and Compliance to Anti-Osteoporotic Medication One Year after Sustained Fragility Fracture Abstract. We were interested why therapy recommendations made by specialists are often not followed by general practitioners (GPs) and patients. We evaluated systematic questionnaires comparing both, patient and GP statements (n = 151 each) with regard to the implementation of and compliance to specific therapy recommended by an osteologic specialist one year after an osteoporotic fracture. In 53 % GPs prescribed antiosteoporotic drugs, more often if the indication for treatment was less aggressive (p <0.001). Once prescribed, in 94 % of cases the GPs' medication followed the specialists' recommendations. 74 % of patients followed their GP's prescription. Patients most often stated a missing prescription as the reason for not taking drugs (39 %), whereas GPs cited a missing interest of their patients (44 %). The observed discrepancies call for a melioration in the communication between all parties involved.

[The recommendations of nephrologist are poorly followed by the primary care physician. The example of vaccination against hepatitis B]. / Les recommandations des néphrologues sont peu suivies par les médecins traitants. L'exemple de la vaccination contre l'hépatite B.

The relationship between specialist physician and primary care physician (PCP) has been poorly evaluated in France. We have studied the application of a specialist's recommendation by the PCP. Vaccination against hepatitis B in patients with chronic renal failure was the follow-up marker. After consultation, the nephrologist wrote in his report to the PCP that the vaccination was recommended. At the next nephrological consultation, the patient was asked if the PCP had proposed vaccination. The clinical, biological characteristics and history of the patients were recorded as well as number and location of the PCP consultations. Five nephrology centers recruited 315 patients. In 61.6% (194/315) of the cases, the vaccination was not proposed by the PCP. Only the estimated GFR (lowest in vaccinated patients, 29.5 vs. 34.5mL/min/1.73m2), the delay between the two consultations of the nephrologist (shorter in vaccinated patients, 18.7 vs. 22.9 weeks) and the nephrologist's practice center (17.5 to 52% vaccination rate) are statistically significant in univariate analysis. In multivariate analysis, only the center effect persists. The lack of vaccination was argued by a letter from the PCP in 2 cases (1%). In the absence of a direct questioning of the PCP, the reasons for not following the recommendation remain unexplained. Overall, the recommendation of the nephrologist was little followed. Our study can contribute to the reflection on the shared follow-up of patients suffering from chronic diseases.

[Reasons for first-consultation in nephrology in the health area 5 of Britanny during the year 2014]. / Motifs de primo-consultations de néphrologie en 2014 dans le territoire de santé 5 de Bretagne.

BACKGROUND: In France, the coordinated healthcare circuit means that patients should be referred to specialists, for example nephrologists, by another physician. However, there are no recommendations concerning the reasons justifying the referral to a nephrologist. The main purpose of our study is to describe the motif of first consultations in nephrology in the health area 5 of Brittany. METHODS: We retrospectively collected medical reports of first consultations by 17 nephrologists in the 4 centers of the study area, during the year 2014. In these letters, we noted the consultation motif, the specialty of the physician who refers the patient, and main characteristics of patients. RESULTS: We included 662 first consultations. The main reason for consultations was chronic kidney disease (68.7%), including chronic renal insufficiency (56.9%), proteinuria (7.3%), microscopic hematuria (3.3%) and searching for chronic kidney disease in the presence of risk factor (1.2%). Other frequent reasons were the follow-up consultation after a pregnancy complicated by preeclampsia (9.5%), urinary lithiasis (5.7%), hypertension (3.8%) and hydroelectrolytic disorder (3.5%). Non-nephrology reasons represent 3.2% of first consultations. Almost all patients have been referred by a physician (99.7%), mainly a general practitioner (71.9%). CONCLUSION: Nephrology first consultations are realized according to the coordinated healthcare circuit since almost all are requested by another physician. The reasons are adapted to the specialty. The main reason is chronic kidney disease, often already associated with renal insufficiency chronic.

The Need Associated with Diabetes Primary Care and the Impact of Referral to a Specialist-Centered Multidisciplinary Diabetes Program (the NADIR Study).

OBJECTIVE: The impact of specialist care on glycemia and cardiovascular risk factors in patients with diabetes is uncertain. This observational cohort study investigated metabolic risk factors in patients referred to LMC Diabetes & Endocrinology for diabetes management. METHODS: The cohort included 306 consecutive patients with diabetes referred to LMC in Ontario between January and June 2010. Sources of prereferral data included consultation notes, records from primary care physicians and the Ontario Lab Information System. Postreferral data were obtained from LMC's patients' records. RESULTS: The mean duration of diabetes before referral was 11 years, and the mean baseline glycated hemoglobin (A1C) level was 8.8%. Among patients with uncontrolled A1C levels at baseline, 73% had had no A1C values ≤7% for up to 6 years before referral. Following referral, mean A1C levels decreased to 7.8% at 6 and 12 months (both p<0.001 vs. baseline). Attendance at diabetes education programs improved from 28% to 67% postreferral, and attendees achieved significantly greater A1C reductions than nonattendees (mean 1.1% vs. 0.7%, respectively). Mean low-density lipoprotein levels declined from 2.3 mmol/L at referral to 1.8 mmol/L at 12 months (p<0.05). Mean blood pressure was similar, at 128/75 before and 129/75 mm Hg after referral; however, following referral, blood pressure improved from 143/89 to 134/80 (p<0.001) in patients with previously uncontrolled blood pressure. Use of guideline-recommended medications increased significantly following referral. CONCLUSION: Referral to specialist care should be considered early in the course of diabetes in order to optimize management of glycemia and cardiovascular risk factors.

[Trends in family medicine--how to sort the wheat from the chaff]. / Trends in der Hausarztmedizin--die Kunst, die Spreu vom Weizen zu trennen.

Considering the trends in medicine, time just seems to move at a slower pace in general practice/family medicine than in the medical specialties. Novel medical drugs and therapeutic modalities appear to take longer to become well-established, and sometimes it never happens. There are obvious gaps between the requirements of the guidelines issued by scientific medical societies and the practical implementation of these guidelines by primary care physicians. In health services research this is known as the «evidence-performance gap¼. The aim of this narrative review is to outline the nature and the dynamics of trends in general practice/family medicine on the one hand and in the medical specialties on the other hand, and to elucidate the potential causes leading to the evidence-performance gaps observed.